Discussion of treatments for Acne:

Health Topics Questions and Answers About Acne: NIDDK (Excerpt)

Acne is often treated by dermatologists (doctors who
specialize in skin problems). These doctors treat all kinds of acne,
particularly severe cases. Doctors who are general or family
practitioners, pediatricians, or internists may treat patients with
milder cases of acne.

The goals of treatment are to heal existing lesions, stop
new lesions from forming, prevent scarring, and minimize the
psychological stress and embarrassment caused by this disease. Drug
treatment is aimed at reducing several problems that play a part in
causing acne: abnormal clumping of cells in the follicles, increased oil
production, bacteria, and inflammation. Depending on the extent of the
person's acne, the doctor will recommend one of several over-the-counter
(OTC) medicines or prescription medicines that are topical (applied to
the skin) or systemic (taken by mouth). The doctor may suggest using
more than one topical medicine or combining oral and topical
medicines.

Treatment for Blackheads,
Whiteheads, and Mild Inflammatory Acne

Doctors usually recommend an OTC or prescription topical
medication for people with mild signs of acne. Topical medicine is
applied directly to the acne lesions or to the entire area of affected
skin.

Benzoyl peroxide, resorcinol, salicylic acid, and sulfur
are the most common topical OTC medicines used to treat acne. Each works
a little differently. Benzoyl peroxide is best at killing P.
acnes and may reduce oil production. Resorcinol, salicylic acid, and
sulfur help break down blackheads and whiteheads. Salicylic acid also
helps cut down the shedding of cells lining the follicles of the oil
glands. Topical OTC medications are available in many forms, such as
gel, lotion, cream, soap, or pad.

In some patients, OTC acne medicines may cause side
effects such as skin irritation, burning, or redness. Some people find
that the side effects lessen or go away with continued use of the
medicine. Severe or prolonged side effects should be reported to the
doctor.

OTC topical medicines are somewhat effective in treating
acne when used regularly. Patients must keep in mind that it can take 8
weeks or more before they notice their skin looks and feels better.

Treatment for Moderate to Severe
Inflammatory Acne

Patients with moderate to severe inflammatory acne may be
treated with prescription topical or oral medicines, alone or in
combination.

Prescription Topical Medicines

Several types of prescription topical medicines are used
to treat acne, including antibiotics, benzoyl peroxide, tretinoin,
adapalene, and azelaic acid. Antibiotics and azelaic acid help stop or
slow the growth of bacteria and reduce inflammation. Tretinoin, a type
of drug called a retinoid that contains an altered form of vitamin A, is
an effective topical medicine for stopping the development of new
comedones. It works by unplugging existing comedones, thereby allowing
other topical medicines, such as antibiotics, to enter the follicles.
The doctor may also prescribe newer retinoids or retinoid-like drugs,
such as tazarotene or adapalene, that help decrease comedo
formation.

Like OTC topical medicines, prescription topical medicines
come as creams, lotions, solutions, or gels. The doctor will consider
the patient's skin type when prescribing a product. Creams and lotions
provide moisture and tend to be good for people with sensitive skin.
Gels and solutions are generally alcohol based and tend to dry the skin.
Therefore, patients with very oily skin or those who live in hot, humid
climates may prefer them. The doctor will tell the patient how to apply
the medicine and how often to use it.

Some people develop side effects from using prescription
topical medicines. Initially, the skin may look worse before improving.
Common side effects include stinging, burning, redness, peeling,
scaling, or discoloration of the skin. With some medicines, like
retinoids, these side effects usually decrease or go away after the
medicine is used for a period of time. Patients should report prolonged
or severe side effects to their doctor. Between 4 and 8 weeks will most
likely pass before patients see their skin improve.

Prescription Oral Medicines

For patients with moderate to severe acne, the doctor
often prescribes oral antibiotics (taken by mouth). Oral antibiotics are
thought to help control acne by curbing the growth of bacteria and
reducing inflammation. Prescription oral and topical medicines may be
combined. For example, benzoyl peroxide may be combined with
clindamycin, erythromycin, or sulfur. Other common antibiotics used to
treat acne are tetracycline, minocycline, and doxycycline. Some people
have side effects when taking these antibiotics, such as an increased
tendency to sunburn, upset stomach, dizziness or lightheadedness, and
changes in skin color. Tetracycline is not given to pregnant women, nor
is it given to children under 8 years of age because it might discolor
developing teeth. Tetracycline and minocycline may also decrease the
effectiveness of birth control pills. Therefore, a backup or another
form of birth control may be needed. Prolonged treatment with oral
antibiotics may be necessary to achieve the desired results.

Treatment for Severe Nodular or
Cystic Acne

People with nodules or cysts should be treated by a
dermatologist. For patients with severe inflammatory acne that does not
improve with medicines such as those described above, a doctor may
prescribe isotretinoin (Accutane*), a retinoid. Isotretinoin is an oral
drug that is usually taken once or twice a day with food for 15 to 20
weeks. It markedly reduces the size of the oil glands so that much less
oil is produced. As a result, the growth of bacteria is decreased.

* Brand names included in this booklet are
provided as examples only, and their inclusion does not mean that these
products are endorsed by the National Institutes of Health or any other
Government agency. Also, if a particular brand name is not mentioned,
this does not mean or imply that the product is
unsatisfactory.

Advantages of Isotretinoin (Accutane)

Isotretinoin is a very effective medicine that can help
prevent scarring. After 15 to 20 weeks of treatment with isotretinoin,
acne completely or almost completely goes away in up to 90 percent of
patients. In those patients where acne recurs after a course of
isotretinoin, the doctor may institute another course of the same
treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

Isotretinoin can cause birth defects in the developing
fetus of a pregnant woman. It is important that women of childbearing
age are not pregnant and do not get pregnant while taking this
medicine. Women must use two separate effective forms of birth
control at the same time for 1 month before treatment begins, during the
entire course of treatment, and for 1 full month after stopping the
drug. They should ask their doctor when it is safe to get pregnant after
they have stopped taking Accutane.

Some people with acne become depressed by the changes in
the appearance of their skin. Changes in mental health may be
intensified during treatment or soon after completing a course of
medicines like Accutane. A doctor should be consulted if a person feels
unusually sad or has other symptoms of depression, such as loss of
appetite or trouble concentrating.

Other possible side effects include dry eyes, mouth, lips,
nose, or skin; itching; nosebleeds; muscle aches; sensitivity to the
sun; and, sometimes, poor night vision. More serious side effects
include changes in the blood, such as an increase in triglycerides and
cholesterol, or a change in liver function. To make sure Accutane is
stopped if side effects occur, the doctor monitors blood studies that
are done before treatment is started and periodically during treatment.
Side effects usually go away after the medicine is stopped.

Treatments for Hormonally
Influenced Acne in Women

Clues that help the doctor determine whether acne in an
adult woman is due to an excess of androgen hormones are hirsutism
(excessive growth of hair in unusual places), premenstrual acne flares,
irregular menstrual cycles, and elevated blood levels of certain
androgens. The doctor may prescribe one of several drugs to treat women
with this type of acne. Low-dose estrogen birth control pills help
suppress the androgen produced by the ovaries. Low-dose corticosteroid
drugs, such as prednisone or dexamethasone, may suppress the androgen
produced by the adrenal glands. Finally, the doctor may prescribe an
antiandrogen drug, such as spironolactone (Aldactone). This medicine
reduces excessive oil production. Side effects of antiandrogen drugs may
include irregular menstruation, tender breasts, headache, and
fatigue.

Other Treatments for Acne

Doctors may use other types of procedures in addition to
drug therapy to treat patients with acne. For example, the doctor may
remove the patient's comedones during office visits. Sometimes the
doctor will inject cortisone directly into lesions to help reduce the
size and pain of inflamed cysts and nodules.

Early treatment is the best way to prevent acne scars.
Once scarring has occurred, the doctor may suggest a medical or surgical
procedure to help reduce the scars. A superficial laser may be used to
treat irregular scars. Another kind of laser allows energy to go deeper
into the skin and tighten the underlying tissue and plump out depressed
scars. Dermabrasion (or microdermabrasion), which is a form of "sanding
down" scars, is sometimes combined with the subsurface laser treatment.
Another treatment option for deep scars caused by cystic acne is the
transfer of fat from one part of the body to the face.
(Source: excerpt from Health Topics Questions and Answers About Acne: NIDDK)

Questions and Answers About Acne: NIAMS (Excerpt)

Acne is often treated by dermatologists (doctors who
specialize in skin problems). These doctors treat all kinds of acne,
particularly severe cases. Doctors who are general or family
practitioners, pediatricians, or internists may treat patients with
milder cases of acne.

The goals of treatment are to heal existing lesions, stop
new lesions from forming, prevent scarring, and minimize the
psychological stress and embarrassment caused by this disease. Drug
treatment is aimed at reducing several problems that play a part in
causing acne: abnormal clumping of cells in the follicles, increased oil
production, bacteria, and inflammation. Depending on the extent of the
person's acne, the doctor will recommend one of several over-the-counter
(OTC) medicines or prescription medicines that are topical (applied to
the skin) or systemic (taken by mouth). The doctor may suggest using
more than one topical medicine or combining oral and topical
medicines.

Treatment for Blackheads,
Whiteheads, and Mild Inflammatory Acne

Doctors usually recommend an OTC or prescription topical
medication for people with mild signs of acne. Topical medicine is
applied directly to the acne lesions or to the entire area of affected
skin.

Benzoyl peroxide, resorcinol, salicylic acid, and sulfur
are the most common topical OTC medicines used to treat acne. Each works
a little differently. Benzoyl peroxide is best at killing P.
acnes and may reduce oil production. Resorcinol, salicylic acid, and
sulfur help break down blackheads and whiteheads. Salicylic acid also
helps cut down the shedding of cells lining the follicles of the oil
glands. Topical OTC medications are available in many forms, such as
gel, lotion, cream, soap, or pad.

In some patients, OTC acne medicines may cause side
effects such as skin irritation, burning, or redness. Some people find
that the side effects lessen or go away with continued use of the
medicine. Severe or prolonged side effects should be reported to the
doctor.

OTC topical medicines are somewhat effective in treating
acne when used regularly. Patients must keep in mind that it can take 8
weeks or more before they notice their skin looks and feels better.

Treatment for Moderate to Severe
Inflammatory Acne

Patients with moderate to severe inflammatory acne may be
treated with prescription topical or oral medicines, alone or in
combination.

Prescription Topical Medicines

Several types of prescription topical medicines are used
to treat acne, including antibiotics, benzoyl peroxide, tretinoin,
adapalene, and azelaic acid. Antibiotics and azelaic acid help stop or
slow the growth of bacteria and reduce inflammation. Tretinoin, a type
of drug called a retinoid that contains an altered form of vitamin A, is
an effective topical medicine for stopping the development of new
comedones. It works by unplugging existing comedones, thereby allowing
other topical medicines, such as antibiotics, to enter the follicles.
The doctor may also prescribe newer retinoids or retinoid-like drugs,
such as tazarotene or adapalene, that help decrease comedo
formation.

Like OTC topical medicines, prescription topical medicines
come as creams, lotions, solutions, or gels. The doctor will consider
the patient's skin type when prescribing a product. Creams and lotions
provide moisture and tend to be good for people with sensitive skin.
Gels and solutions are generally alcohol based and tend to dry the skin.
Therefore, patients with very oily skin or those who live in hot, humid
climates may prefer them. The doctor will tell the patient how to apply
the medicine and how often to use it.

Some people develop side effects from using prescription
topical medicines. Initially, the skin may look worse before improving.
Common side effects include stinging, burning, redness, peeling,
scaling, or discoloration of the skin. With some medicines, like
retinoids, these side effects usually decrease or go away after the
medicine is used for a period of time. Patients should report prolonged
or severe side effects to their doctor. Between 4 and 8 weeks will most
likely pass before patients see their skin improve.

Prescription Oral Medicines

For patients with moderate to severe acne, the doctor
often prescribes oral antibiotics (taken by mouth). Oral antibiotics are
thought to help control acne by curbing the growth of bacteria and
reducing inflammation. Prescription oral and topical medicines may be
combined. For example, benzoyl peroxide may be combined with
clindamycin, erythromycin, or sulfur. Other common antibiotics used to
treat acne are tetracycline, minocycline, and doxycycline. Some people
have side effects when taking these antibiotics, such as an increased
tendency to sunburn, upset stomach, dizziness or lightheadedness, and
changes in skin color. Tetracycline is not given to pregnant women, nor
is it given to children under 8 years of age because it might discolor
developing teeth. Tetracycline and minocycline may also decrease the
effectiveness of birth control pills. Therefore, a backup or another
form of birth control may be needed. Prolonged treatment with oral
antibiotics may be necessary to achieve the desired results.

Treatment for Severe Nodular or
Cystic Acne

People with nodules or cysts should be treated by a
dermatologist. For patients with severe inflammatory acne that does not
improve with medicines such as those described above, a doctor may
prescribe isotretinoin (Accutane*), a retinoid. Isotretinoin is an oral
drug that is usually taken once or twice a day with food for 15 to 20
weeks. It markedly reduces the size of the oil glands so that much less
oil is produced. As a result, the growth of bacteria is decreased.

* Brand names included in this booklet are
provided as examples only, and their inclusion does not mean that these
products are endorsed by the National Institutes of Health or any other
Government agency. Also, if a particular brand name is not mentioned,
this does not mean or imply that the product is
unsatisfactory.

Advantages of Isotretinoin (Accutane)

Isotretinoin is a very effective medicine that can help
prevent scarring. After 15 to 20 weeks of treatment with isotretinoin,
acne completely or almost completely goes away in up to 90 percent of
patients. In those patients where acne recurs after a course of
isotretinoin, the doctor may institute another course of the same
treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

Isotretinoin can cause birth defects in the developing
fetus of a pregnant woman. It is important that women of childbearing
age are not pregnant and do not get pregnant while taking this
medicine. Women must use two separate effective forms of birth
control at the same time for 1 month before treatment begins, during the
entire course of treatment, and for 1 full month after stopping the
drug. They should ask their doctor when it is safe to get pregnant after
they have stopped taking Accutane.

Some people with acne become depressed by the changes in
the appearance of their skin. Changes in mental health may be
intensified during treatment or soon after completing a course of
medicines like Accutane. A doctor should be consulted if a person feels
unusually sad or has other symptoms of depression, such as loss of
appetite or trouble concentrating.

Other possible side effects include dry eyes, mouth, lips,
nose, or skin; itching; nosebleeds; muscle aches; sensitivity to the
sun; and, sometimes, poor night vision. More serious side effects
include changes in the blood, such as an increase in triglycerides and
cholesterol, or a change in liver function. To make sure Accutane is
stopped if side effects occur, the doctor monitors blood studies that
are done before treatment is started and periodically during treatment.
Side effects usually go away after the medicine is stopped.

Treatments for Hormonally
Influenced Acne in Women

Clues that help the doctor determine whether acne in an
adult woman is due to an excess of androgen hormones are hirsutism
(excessive growth of hair in unusual places), premenstrual acne flares,
irregular menstrual cycles, and elevated blood levels of certain
androgens. The doctor may prescribe one of several drugs to treat women
with this type of acne. Low-dose estrogen birth control pills help
suppress the androgen produced by the ovaries. Low-dose corticosteroid
drugs, such as prednisone or dexamethasone, may suppress the androgen
produced by the adrenal glands. Finally, the doctor may prescribe an
antiandrogen drug, such as spironolactone (Aldactone). This medicine
reduces excessive oil production. Side effects of antiandrogen drugs may
include irregular menstruation, tender breasts, headache, and
fatigue.
(Source: excerpt from Questions and Answers About Acne: NIAMS)

Acne: NWHIC (Excerpt)

There are many treatments for common acne. Many are mild with few side
effects. Others cause dangerous side effects in some women. The trick is
to use the mildest treatment that works for you.

Over-the-counter medications containing benzoyl peroxide help prevent
whiteheads and blackheads from forming and kill the bacteria that cause
pimples. They are good to treat mild acne.

For more severe cases, a health care provider can prescribe antibiotic
lotions or gels, as well as retinoic acid, a Vitamin A derivative that
helps prevent whiteheads and blackheads from forming. Antibiotic pills are
also helpful. Some women break out mainly around their menstrual periods,
so taking antibiotic pills right around that time monthly can help.
Retinoic acid and antibiotic pills can sensitize skin to the sun, so it's
important to wear sunscreen and avoid the sun while using them.

For severe, scarring acne with large pimples called cysts, isotretinoin
(Accutane ®) can be used. This is powerful medication that also causes
severe birth defects. For this reason, it should only be used for severe
acne when other treatments are not working. It should be prescribed and
monitored by a knowledgeable health care provider. Side effects include
dry eyes and mouth, and blood test abnormalities. Never take Accutane ®
that was prescribed for someone else. (Source: excerpt from Acne: NWHIC)

Acne: NWHIC (Excerpt)

Some birth control pills can make acne better. This is because the
hormones in the pill can balance out the hormones that are causing the
oily sebum, which causes acne. If you have other reasons to use the birth
control pill, ask your health care provider about choosing a pill, which
can also help your acne. Some women have hormonal imbalances in which the
birth control pill might be the first choice to treat acne even if they
don't need it to prevent pregnancy. Talk it over with your health care
provider. (Source: excerpt from Acne: NWHIC)

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